Dengue Hemorrhagic Fever: A State-of-the-Art Review Focused in Pulmonary Involvement

Abstract

Dengue fever is an arboviral disease transmitted to humans through the bites of infected female Aedes mosquitoes. Dengue virus is a member of the Flaviviridae family, and human infection can be caused by any of the four antigenically distinct serotypes (DENV 1-4). The infection has become recognized as the most important and prevalent arboviral disease in humans, endemic in almost 100 countries worldwide. Nearly 3 billion people live in areas with transmission risk. Autochthonous transmission of the virus in previously disease-free areas, increased incidence in endemic areas, and epidemic resurgence in controlled regions could increase the risk of contracting more severe forms of the disease, such as dengue hemorrhagic fever (DHF)/dengue shock syndrome (DSS). Symptomatic dengue virus infection can present with a wide range of clinical manifestations, from mild fever to life-threatening DSS. Thoracic complications may manifest as pleural effusion, pneumonitis, non-cardiogenic pulmonary edema, and hemorrhage/hemoptysis. No vaccine is currently available and no specific treatment for dengue fever exists, but prevention and prompt management of complications in patients with DHF can help reduce mortality. This review describes the main clinical, pathological, and imaging findings of thoracic involvement in DHF.

Pulmonary manifestations of dengue

“…The dengue virus (DENV) belongs to the Flaviviridae family, and humans can be infected with any of the four antigenically distinct serotypes (DENV 1-4). (1)(2)(3)(4)(5)(6)(7) The prevalence of DENV infection has increased dramatically in recent decades; the disease is now endemic in > 100 countries worldwide. The global resurgence of dengue is thought to be due to the failure to control Aedes spp.…”

“…Hemoptysis has been reported in 1.4% of DENV infections. (5)(6)(7)9,10) The early diagnosis of dengue can be established provisionally by clinical observation and readily available laboratory tests. In general, laboratory findings of dengue include neutropenia followed by lymphocytosis, the presence of atypical lymphocytes, and moderate to marked thrombocytopenia with concurrent hemoconcentration.…”

“…Parenchymal abnormalities, including ground-glass opacities and consolidations, are less common, have no specific distribution pattern, and can be accompanied by interlobular septal thickening and nodules, representing edema or pulmonary hemorrhage (Figure 1). (6,7,(9)(10)(11) We had the opportunity to review the CT findings of 9 patients with severe dengue confirmed by serology. The most common CT findings were multifocal ground-glass opacities, which were seen in 8 patients (88.9%).…”

“…Those conditions can occur in similar epidemiological contexts, increasing the diagnostic challenge. (6,7) Morphologically, lung tissue from patients with dengue shows interstitial edema and pneumonia, accompanied by focal or diffuse zones of alveolar congestion/hemorrhage and an increased number of alveolar macrophages, as well as the recruitment of platelets, mononuclear cells, and polymorphonuclear cells. Hyaline membranes may also be found.…”

“…Hyaline membranes may also be found. (6,7,9,11) No specific treatment for dengue is available. However, careful clinical management frequently saves the lives of patients with pulmonary hemorrhage.…”